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PLoS Med. Download references. We are most grateful to the participants of the HELIUS study and the management team, research nurses, interviewers, research assistants en other staff who have taken part in gathering the data of this study.
You can also search for this author in PubMed Google Scholar. Correspondence to Karien Stronks. KS drafted the manuscript. All authors read and approved the final manuscript. This article is published under license to BioMed Central Ltd. Reprints and Permissions. Stronks, K. BMC Public Health 13, Download citation. Received : 19 February Accepted : 17 April Published : 27 April Anyone you share the following link with will be able to read this content:.
Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Abstract Background Populations in Europe are becoming increasingly ethnically diverse, and health risks differ between ethnic groups. Background Prospective population-based cohort studies have significantly increased our understanding of risk factors for the major causes of the global burden of disease.
Immaturity-related conditions, such as respiratory and cardiovascular disorders, contribute most to infant mortality in most ethnic groups; however, in the Pakistani and Bangladeshi groups congenital anomalies cause the most infant deaths. Babies of South Asian women have a lower rate of unexplained deaths in infancy. Explanations for these ethnic variations in infant mortality are complex, involving the interplay of environmental, physiological and socio-cultural factors. Deprivation is a significant risk factor: compared with white groups, higher proportions of mothers from ethnic minority groups, especially Black groups, live in deprived areas.
Table 2 Live births, stillbirths and infant mortality by ethnic group, England and Wales. Health and wellbeing in the early years have a significant bearing on future health. Childhood obesity rates are higher among Black and Asian children see Table 3. Some of these differences may be associated with higher levels of deprivation among ethnic minority groups, as children in deprived areas are twice as likely to be obese than those in less-deprived areas.
South Asian children also have lower levels of physical fitness than children in white European and Black groups, and physical activity levels are lower among children from Bangladeshi and Pakistani groups. Department for Work and Pensions Archives of Disease in Childhood , vol , pp — Journal of Epidemiology and Community Health , vol 72, no 10, pp —8.
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National Audit Office Childhood obesity. London: National Audit Office. BMJ Open , vol 6, art no: e Office for National Statistics website.
Cardiovascular disease 5 CVD is a leading cause of death nationally and in ethnic minority groups, causing 24 per cent of all deaths in England and Wales in It is a significant contributor to inequalities in life expectancy and a risk factor for poor outcomes from Covid Up to 80 per cent of premature deaths from CVD are preventable through better public health. Diabetes increases the risk of CVD almost two-fold.
South Asian groups have the highest mortality from heart disease and also develop heart disease at a younger age. As with heart disease, stroke incidence and mortality are also higher in the South Asian population. CVD mortality is high and rising in South Asia, in contrast to the declining trend elsewhere.
These patterns are associated with a higher clustering in South Asians of risk factors 6 that increase the risk of heart disease, stroke and diabetes. In terms of other risk factors, although smoking prevalence is lower among South Asian groups, they have low physical activity rates, especially among women.
The causes of increased CVD risk among South Asian groups are multifactorial and include physiological susceptibility, environmental determinants such as deprivation, and adverse changes to lifestyle and diet following migration.
In contrast to South Asian groups, Black groups in the UK have a significantly lower risk of heart disease compared to the majority of the population, despite having a high prevalence of hypertension and diabetes risk factors for heart disease and stroke. Lower cholesterol levels among people of African Caribbean heritage than white Europeans may protect them against heart disease.
Heart disease rates are low in sub-Saharan Africa and the Caribbean. However, Black groups have higher-than-average incidence of and mortality from hypertension and stroke, and they have strokes at a younger age. The prevalence of hypertension, a risk factor for stroke, is high in Africa and the West Indies.
Recent evidence suggests that greater awareness among health care providers of the CVD risk in South Asian populations, earlier diagnosis and improved management of diabetes and CVD, together with second-generation adopting healthier lifestyles than first-generation migrants, have reduced CVD mortality risks relative to white Europeans.
Research also indicates that South Asian groups have equitable access to care for heart disease and better survival rates from it. In contrast, Black groups have lower than expected rates of access to and use of cardiovascular care.
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NHS Digital website. National Institute for Health and Care Excellence Public health guideline [46]. NICE website. ONS: website. Public Health Outcomes Framework: health equity report [online]. Journal of Stroke and Cerebrovascular Diseases , vol 26, no 10, pp — Stroke Association undated. Stroke and South Asian people. Stroke Association website. Stroke Association State of the nation: stroke statistics [online].
Theuri C FaceFace website. Circulation , vol , no 1, pp e1-e BMJ , vol , pp Circulation , vol , no 23, pp — Diabetes 7 see references is a long-term condition that can cause serious secondary complications and premature death if it is not well managed.
This explainer considers type-2 diabetes. Being overweight, abdominal obesity and physical inactivity are risk factors for diabetes. The prevalence of diabetes is higher among South Asian and Black groups than in the white population and people in these groups develop the condition at a younger age.
The risk of developing diabetes is up to six times higher in South Asian groups than in white groups and South Asian groups have higher mortality from diabetes. South Asians with diabetes have a higher risk of developing secondary complications of cardiovascular and end-stage renal disease. However, recent studies show that excess CVD mortality in South Asians with diabetes has reduced and overall mortality is lower than in the white group.
Explanations for the high prevalence of diabetes among South Asian groups include a mix of biological, lifestyle and socio-economic factors. As with CVD, these patterns are associated with a clustering in South Asians of risk factors see footnote 3 that increase the risk of diabetes, exacerbated by socio-economic disadvantage and changing lifestyles after migration.
Diabetes prevalence in Black groups is up to three times higher than in the white population and they have higher mortality from diabetes; they also have a higher risk of hypertension and stroke but, unlike South Asians, are less prone to heart disease. The physiological pathways and impacts of diabetes therefore differ between ethnic minority groups.
Diabetes-related co-morbidities in Black groups are similar to or lower than in white groups, except for higher rates of end-stage renal disease. Like South Asians, excess mortality associated with diabetes is lower in Blacks groups than in the white population. A recent study found improved diabetes outcomes in South Asians are attributable, in part, to earlier diagnosis and risk factor management, indicating increased awareness among health care providers, equity of access and standardisation of care for long-term conditions incentivised in the Quality and Outcomes Framework for GPs.
It also found little evidence of inequalities in the management of diabetes among Black patients at initial diagnosis, indicative of a wider trend of shrinking inequalities in diabetes care. It can lead to serious secondary complications.
Some women can develop gestational diabetes during pregnancy. About 90 per cent of people with diabetes have type-2 diabetes, which is potentially preventable.
Cardiovascular Diabetology , vol 17, no 1, pp Davis TME Diabetic Medicine , vol 25, suppl 2, pp 52—6. Diabetic Medicine , vol 31, no 2, pp —7. Goff L M Diabetic Medicine , vol 36, no 8, pp — Annals of the New York Academy of Sciences , vol , pp 51— British Journal of Cardiology , vol 25, suppl 2, pp s8— Diabetologia , vol 62, no 8, pp — Current Diabetes Reports , vol 17, no Diabetes Care , vol 28, no 9, pp —8.
Diabetes Research and Clinical Practice , no Learn more. To maximize protection from the Delta variant and prevent possibly spreading it to others, get vaccinated as soon as you can and wear a mask indoors in public if you are in an area of substantial or high transmission. Updated Apr. Minus Related Pages. On This Page. Facebook Twitter LinkedIn Syndicate. Last Updated Apr. These ideas have long been discredited.
More recent research into the distribution of health has centred on ethnicity rather than race, but defining ethnicity is complex Mason, Broadly, it refers to the identification of population groups based on social, cultural and historical variations. Ethnic groups are characterised by organised cultural boundaries such as language, religion and country of origin Platt, Ethnicity is a subjective concept, comprising both self-identification and categorisation Mason, Individuals can recognise themselves as belonging to a particular group, with their perception of their own ethnicity influenced by the way they act and think, so ethnicity can be considered as an active construction of its members.
At the same time, however, individuals can be categorised by others as belonging to a particular ethnic group. The arbitrary nature of how an ethnic group is defined is challenging for health researchers, as understanding varies culturally and historically Annandale, In Britain, statistics are largely drawn from government data, but this is based on varying interpretations of what constitutes an ethnic group.
Examples from the most recent census include white British, white and black Caribbean, black British of African or Caribbean origin , gypsy and Irish traveller, Indian and Pakistani classifications Office for National Statistics, However, researchers have no choice but to use these classifications Annandale, ; Box 2 shows the ethnicity question recommended for use in England. Box 2. Recommended question on ethnicity.
What is your ethnic group? Choose one option that best describes your ethnic group or background. Attempts to understand the impact of ethnicity as a social factor are hampered by the fact that there are few large-scale survey data sets reflecting the social distribution of health among ethnic groups Annandale, However, data from a variety of independent and academic sources allows us to establish a broad picture.
There are also geographical health inequalities among minority ethnic groups; London has the greatest disparities. Mental health studies show that Afro-Caribbeans display higher levels of depression and rates of schizophrenia than the majority of the population Rogers and Pilgrim, In general, BME groups are over-represented in mental health inpatient settings Rogers and Pilgrim, Conventional wisdom is that minority ethnic groups display higher levels of poor health, but the health of some is better than in the majority population.
Evidence suggests people of Asian origin are less prone to depression and anxiety compared with the white British population, while Afro-Caribbean individuals are less prone to anxiety Rogers and Pilgrim, Many efforts to explain health disparities have reduced them to cultural factors, suggesting the origins of ill health are found in the cultural norms and values of the minority group, with any disadvantage resulting from their own practices or attitudes.
The second article in this series Matthews, argued that socioeconomic status affects health. With the number of people from minority ethnic groups experiencing social deprivation, poverty and unemployment on a scale greater than the majority population Barry and Yuill, , research has begun to show socioeconomic inequality as a principal cause of the health disparities experienced by these groups Nazroo, From research conducted in the s, Nazroo concluded there was a strong relationship between socioeconomic status and the health of all ethnic minorities as, once the impact of socioeconomic status was removed, the risk of poor health fell.
Evidence from the US supports this, with high-income white and black groups displaying better health than lower-income counterparts Williams, While socioeconomic status has a significant impact, when factors accounting for this are adjusted, there remain health disparities between minority ethnic groups and the ethnic majority.
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